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Troponin T in elders with suspected acute coronary syndromes
Thomas P Noeller1, Stephen W Meldon, W Frank Peacock
1Department of Emergency Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue/E-19, Cleveland, OH 44195, USA. noellet@attbi.org
Insights
Troponin T (TnT) elevations predict adverse outcomes in acute coronary syndromes (ACS). However, TnT specificity is lower in older adults and those with renal insufficiency, requiring careful interpretation.
Area of Science:
- Cardiology
- Biomarkers
- Geriatric Medicine
Background:
- Elevated Troponin T (TnT) levels (≥0.1 ng/mL) signify heightened risk in acute coronary syndromes (ACS).
- Limited data exists on the prognostic value of TnT in elderly patients with ACS.
- This study addresses the prognostic significance of TnT in older adults with suspected ACS.
Purpose of the Study:
- To evaluate the predictive ability of TnT for adverse outcomes in elderly patients with suspected ACS.
- To compare the prognostic value of TnT in older adults (≥65 years) versus younger patients (<65 years).
- To assess the impact of renal insufficiency on TnT specificity in both age groups.
Main Methods:
- Nested cohort study design.
- Inclusion of patients with suspected ACS, stratified by age (<65 and ≥65 years).
- Serial electrocardiograms (ECGs), creatine kinase-MB (CKMB), and TnT assays at presentation and 4, 8, 16 hours.
- Adverse outcomes defined as in-hospital death, nonfatal myocardial infarction, coronary artery bypass grafting, or positive cardiac catheterization.
Main Results:
- A total of 695 patients were enrolled; 301 (48%) were aged 65 or older.
- No significant difference in TnT sensitivity was observed between younger and older cohorts.
- TnT specificity was significantly lower in the older cohort (83%) compared to the younger cohort (94%) (P < .01).
- Renal insufficiency was associated with significantly reduced TnT specificity in both age groups.
Conclusions:
- While TnT sensitivity is comparable, its specificity is reduced in elderly patients with suspected ACS.
- Renal insufficiency further diminishes TnT specificity in both elderly and younger patients.
- Careful consideration of TnT results is warranted, especially in patients with impaired renal function, as a sole criterion for aggressive management.
Abstract:
Troponin T (TnT) elevations (> or =0.1 ng/mL) indicate an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). There is little data on the prognostic significance of TnT in elders with ACS. We sought to define the ability of TnT to predict adverse outcomes in elders with suspected ACS compared with the younger cohort. This is a nested cohort study of patients aged <65 and > or =65 years with suspected ACS. Serial ECGs, CKMB and TnT assays were obtained at presentation and 4, 8, and 16 hours later. Adverse outcomes at hospital discharge included death, nonfatal myocardial infarction, coronary artery bypass grafting, and positive cardiac catheterization. A total of 695 patients were enrolled. A total of 301 (48%) were aged 65 or older. Although there was no difference in TnT sensitivity between the younger and older cohorts, there was a difference in specificity, 94% versus 83% (P <.01), respectively. In both cohorts, renal insufficiency was associated with a significantly lower TnT specificity. In both elders and younger patients with abnormal renal function, low TnT specificity warrants careful consideration of this marker as the sole criterion for aggressive medical management.